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首页> 外文期刊>Neurocirugia >Early mortality in spontaneous supratentorial intracerebral haemorrhage
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Early mortality in spontaneous supratentorial intracerebral haemorrhage

机译：自发性幕上脑出血的早期死亡率

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Background: Spontaneous supratentorial intracerebral haemorrhage is a severe, frequent, and poorly understood condition. Despite the publication of 12 randomised controlled trials on this subject, the role of surgery remains controversial and no treatment has proved to be effective. We report on a ten year prospective cohort study based on a defined population treated with or without surgery and their outcome in terms of early survival. Methods: Population based, ten year prospective observational study directed to patients consecutively admitted to the Intensive Care Unit (ICU) in a tertiary centre with spontaneous supratentorial intracerebral haemorrhage. Patients were distributed in five groups according to the Glasgow Coma Score (GCS) at admission. Haemorrhages were classified as deep-seated or superficial. All patient received standard medical care, and additionally surgery if it was found indicated by the duty neurosurgeon. Primary endpoint was early mortality defined as dead occurred by any cause during the admission in the ICU. Findings: During the ten year period, 1.485 patients were admitted to our centre with primary intracerebral haemorrhage. Of these, 376 were admitted to the intensive care unit and 285 sustained supratentorial haemorrhages. Low GCS was strong predictor of early mortality. Despite the larger size of haematomas in patients undergoing surgical evacuation, surgery was associated with lower early mortality in all GCS subgroups. Maximal benefit was observed in patient with admission GCS of 4-8. Superficial haematomas were operated on more often, and were associated with lower mortality rate than deep-seated cases. Conclusions: Our findings suggest that craniotomy for haematoma evacuation may reduce early mortality in patients with primary supratentorial intracerebral haemorrhage. Surgery seems specially useful in patients with admission GCS between 4 and 8, and in those with superficial haemorrhages.
机译：背景：自发性幕上脑内出血是一种严重，频繁且鲜为人知的疾病。尽管发表了关于该主题的12项随机对照试验，但手术的作用仍存在争议，没有疗法被证明是有效的。我们报告了一项为期十年的前瞻性队列研究，该研究基于经过手术或未经手术治疗的既定人群及其在早期生存方面的结果。方法：基于人群的十年前瞻性观察性研究，针对的是连续自发性幕上脑内出血的三级中心重症监护病房（ICU）入院的患者。入院时根据格拉斯哥昏迷评分（GCS）将患者分为五组。出血分为深部或浅表性。所有患者均接受了标准的医疗护理，并且如果值班神经外科医生发现有需要，还进行了手术。主要终点是早期死亡，定义为ICU入院期间由于任何原因死亡。结果：在十年期间，有1.485例患者因原发性脑出血入院。其中，有376名进入重症监护病房，有285例持续性幕上出血。低GCS是早期死亡率的有力预测指标。尽管接受手术疏散的患者血肿较大，但所有GCS亚组的手术死亡率均较低。入院GCS为4-8的患者观察到最大获益。浅表血肿的手术频率更高，与深部病例相比，死亡率更低。结论：我们的研究结果表明，开颅行血肿清除术可降低原发性幕上脑内出血患者的早期死亡率。对于入院GCS在4至8之间的患者以及浅表出血的患者，手术似乎特别有用。

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